Survey of Pediatricians' Opinions on Donation After Cardiac Death: Are the Donors Dead?

Abstract

OBJECTIVE. There has been debate in the ethics literature as to whether the donation-after-cardiac-death donor is dead after 5 minutes of absent circulation. We set out to determine whether pediatricians consider the donation-after-cardiac-death donor as dead. METHODS. A survey was mailed to all 147 pediatricians who are affiliated with the university teaching children's hospital. The survey had 4 pediatric patient scenarios in which a decision was made to donate organs after 5 minutes of absent circulation. Background information described the organ shortage, and the debate about the term “irreversibility” applied to death in donation after cardiac death. Descriptive statistics were used, with responses between groups compared by using the χ2 statistic. RESULTS. The response rate was 54% (80 of 147). In each scenario, when given a patient described as dead with absent circulation for 5 minutes, ≤60% of respondents strongly agreed/agreed that the patient is definitely dead, ≤50% responded that the patient is in the state called “dead,” and ≤56% strongly agreed/agreed that the physicians are being truthful when calling the patient dead. On at least 1 of the scenarios, 38 (48%) of 147 responded uncertain, disagree, or strongly disagree that the patient is definitely dead. Although the patients in the 4 scenarios were in the identical physiologic state, with absent circulation for 5 minutes, 12 (15%) of 80 respondents did not consistently consider the patients in the state called “dead” between scenarios. Fewer than 5% of respondents answered strongly agree/agree to allow donation after cardiac death while also answering disagree/strongly disagree that the patient is definitely dead, suggesting little support to abandon the dead-donor rule. CONCLUSIONS. Most pediatrician respondents were not confident that a donation-after-cardiac-death donor was dead. This suggests that additional debate about the concept of irreversibility applied to donation after cardiac death is needed.